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Upcoming changes to mom/baby claims submission process

October 2, 2013

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IBC is making system and process changes that will affect the way we do business with you. These changes will offer greater capabilities, increased flexibility in benefit design, and enhanced functionalities for an improved overall customer experience.

Effective November 1, 2013, mom and baby inpatient hospital claims must be submitted as separate claims ? one for the mom and one for the baby ? and you will receive two separate Statements of Remittance (SOR).

For mom/well-baby claims, payment details will show on the mom?s SOR, as shown in the examples below. There will be no payment information on the well-baby?s SOR. Sick-baby dates of service will pay at the contracted rate, and the payment details will be on the baby?s SOR.*

Current state (prior to November 1, 2013):


Claim ID DRG Rev code Billed charges Payment Comments 11111 765 120 15,000 5,000 Mom delivery line; line will pay 11111 765 170 4,000 0 Well-baby line; line will not pay Total 19,000 5,000

Future state (on or after to November 1, 2013):


Claim ID DRG Rev code Billed charges Payment Comments 11111 765 120 15,000 5,000 Mom delivery line; line will pay
Claim ID DRG Rev code Billed charges Payment Comments 22222 795 170 4,000 0 Baby claim; line will not pay if mom is inpatient

*As per the terms of your contract

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